正常人和草酸钙结石病人尿草酸钙晶体基质

以改良Ｍｏｒｓｅ和Ｒｅｓｎｉｃｋ法提取１０例上尿路草酸钙结石病人和１１例正常人的尿草酸钙晶体基璺，用双向聚丙烯酰胺凝胶电泳对晶体基质及结晶前后大分子物的蛋白质组成进行了比较分析。     

复发性泌尿系结石患者24h尿枸橼酸盐含量的病例对照研究及结石成分分析

目的:分析复发性泌尿系结石患者尿枸橼酸排泄量与结石成分及微观形态,探讨泌尿系结石形成与复发的防治措施。方法:采用病例对照的研究方法,比较复发性泌尿系结石患者与对照组之间的尿枸橼酸排泄量,并运用红外光谱、X线衍射及扫描电镜分析复发性结石的成分与微观形态。结果:复发性结石患者尿枸橼酸排泄量显著低于对照组。结石的成分以草酸钙(80%)和尿酸结石(33%)为主。结论:结石患者术后的代谢分析、严格随访和适量的枸橼酸盐补充,可能在一定程度上降低泌尿系结石的复发率。泌尿系结石的成分分析可为制定预防结石复发方案提供理论依据。     

阴极发光技术在尿石分析上的应用

应用地质矿物学的阴极发光技术，研究１７枚含有各种成分的尿石，发现这种方法有独特的优越性。各种结石成分呈现不同颜色的荧光，尿酸和尿酸盐呈亮监紫色，胱氨酸亮蓝绿色，草酸钙灰蓝至深蓝色，磷酸钙淡红紫色，磷酸镁铵亮红紫色，容易区别。尤其对于混在其他成分中的少量晶体或微晶，也可因色调对比而明显看出。用此法还确认了以前用偏光显微镜发现的草酸钙代磷灰石的现象，发现草酸钙交代尿酸盐现象。     

组配碎石吸石系统处理尿路结石

目的 探讨利用原有器械组配碎石吸石系统,处理膀胱结石、肾结石等尿路结石的方法.方法 2010年12月至2011年8月收治膀胱结石患者4例.均为男性.年龄42～79岁,平均63岁.两例合并尿道狭窄,其中一例患者曾有骨盆骨折、尿道断裂史,尿道狭窄几近闭锁,留置有膀胱造瘘管.另两例为前列腺增生合并膀胱结石.通过医院原有设备,...     

High urinary excretion level of citrate and magnesium in children: potential etiology for the reduced incidence of pediatric urolithiasis

It is well known that the incidence of calcium oxalate (CaOX) urolithiasis is much lower in children than in adults [2, 21]. One purpose of this study was to compare the inhibitory activity on CaOX crystal growth and nucleation of urine from children (ufC) with that of urine from adults (ufA). Another was to measure low molecular weight urinary substances related to CaOX lithiasis, including citrate and magnesium, which have been identified as stone inhibitors. The excretion volume per body weight of uric acid, phosphorus, magnesium and citrate was all significantly higher in 24-h ufC than in 24-h ufA, but that of calcium and oxalate was not. The growth inhibitory activities against CaOX crystals of ufC and ufA were measured in a whole urine system. The diameter of the crystals produced in this system was smaller for ufC (3.68 μm) than for ufA (4.66 μm). We also examined the metastable limit for CaOX with fresh spot urine, which was 3.15 mmol/l in ufC and 0.41 mmol/l in ufA. These results indicate that ufC has a more powerful inhibitory effect on CaOX crystal growth and nucleation than ufA. We also found that the excretion rate of citrate and magnesium in ufC was much higher than in ufA. We suggest that these two stone inhibitors are very likely to elevate the inhibitory activity of ufC against CaOX crystal growth and nucleation. The lower incidence of CaOX lithiasis in children might thus be partly attributed to citrate and magnesium. Received: 30 July 1997 / Accepted: 27 November 1997     

输尿管镜下气压弹道碎石术治疗泌尿系结石(附150例报告)

目的探讨输尿管镜下气压弹道碎石术治疗泌尿系结石的临床疗效。方法自１９９４年８月至１９９７年１２月,采用输尿管镜下气压弹道碎石术治疗输尿管结石１４５例,尿道结石５例。结果一次性结石粉碎率为７９３％（１１９／１５０）,并发症发生率为５３％（８／１５０）,主要是输尿管穿孔及感染。结论此碎石方法安全、效果确切、损伤小,如与ＥＳＷＬ等体外碎石方法结合应用疗效更佳。     

Effect of potential renal acid load of foods on urinary citrate excretion in calcium renal stone formers

The aim of this study was to investigate the influence of the potential renal acid load (PRAL) of the diet on the urinary risk factors for renal stone formation. The present series comprises 187 consecutive renal calcium stone patients (114 males, 73 females) who were studied in our stone clinic. Each patient was subjected to an investigation including a 24-h dietary record and 24-h urine sample taken over the same period. Nutrients and calories were calculated by means of food composition tables using a computerized procedure. Daily PRAL was calculated considering the mineral and protein composition of foods, the mean intestinal absorption rate for each nutrient and the metabolism of sulfur-containing amino acids. Sodium, potassium, calcium, magnesium, phosphate, oxalate, urate, citrate, and creatinine levels were measured in the urine. The mean daily PRAL was higher in male than in female patients (24.1±24.0 vs 16.1±20.1 mEq/day, P=0.000). A significantly (P=0.01) negative correlation (R=−0.18) was found between daily PRAL and daily urinary citrate, but no correlation between PRAL and urinary calcium, oxalate, and urate was shown. Daily urinary calcium (R=0.186, P=0.011) and uric acid (R=0.157, P=0.033) were significantly related to the dietary intake of protein. Daily urinary citrate was significantly related to the intakes of copper (R=0.178, P=0.015), riboflavin (R=0.20, P=0.006), piridoxine (R=0.169, P=0.021) and biotin (R=0.196, P=0.007). The regression analysis by stepwise selection confirmed the significant negative correlation between PRAL and urinary citrate (P=0.002) and the significant positive correlation between riboflavin and urinary citrate (P=0.000). Urinary citrate excretion of renal stone formers (RSFs) is highly dependant from dietary acid load. The computation of the renal acid load is advisable to investigate the role of diet in the pathogenesis of calcium stone disease and it is also a useful tool to evaluate the lithogenic potential of the diet of the individual patient.     

有关制动综合征尿石形成危险因素及其防治

对２７例非泌尿系感染卧床早期病人进行了观察和研究：１５例患者的尿钙、尿磷、尿尿酸均明显高于健康人，成石相对概率值分别增加０．４０、０．３７、０．３５及０．２９，（Ｐｓｆ）均超过正常值上限；１２例患者服用双氢克尿噻（ＤＨＣＴ）后，２４小时尿钙于第２－４周分别下降０．２４、０．３９及０．３５，第４周Ｐｓｆ值均降至正常范围，结果认为：卧床制可增加泌尿系结石形成的危险性，ＤＨＣＴ是防治卧床病人尿石形成的有     

瞬时受体电位类香草醛5和骨桥蛋白在泌尿系统结石患者中的表达及其与微小RNA-22-3p的关系

目的检测瞬时受体电位类香草醛5(TRPV5)和骨桥蛋白(OPN)在泌尿系统结石患者中的表达及其与微小核糖核酸-22-3p(miR-22-3p)的关系。方法荧光定量反转录-聚合酶链式反应(RT-qPCR)检测健康体检者、非泌尿系统结石患者和泌尿系统结石血清TRPV5、OPN和miR-22-3p表达并分析其相关性。将模型+miR-con组(转染miR-con)、模型+miR-22-3p组(转染miR-22-3p)转染至HK-2细胞并草酸钙结石晶体溶液(100 mg/L)处理。流式细胞仪检测细胞凋亡;蛋白质印迹法(Western blot)检测抗裂解的半胱氨酸天冬氨酸蛋白酶-3(cleaved Caspase-3)、B淋巴细胞瘤-2(bcl-2)和bcl-2相关X蛋白(bax)表达。两组间比较采用t检验,多组间比较采用单因素方差分析联合SNK-q检验。采用Pearson相关性分析法分析相关性。结果与健康体检者或非泌尿系统结石患者比较,泌尿系统结石患者血清TRPV5和miR-22-3p表达显著降低(TRPV5分别为0.66±0.15、1.06±0.26、0.77±0.21,miR-22-3p分别为0.62±0.18、1.00±0.23、0.83±0.19),OPN表达显著升高(2.78±0.49、1.07±0.21、1.60±0.20),差异有统计学意义(F=43.908、300.788、41.410,P<0.05)。泌尿系统结石患者血清中miR-22-3p的表达量与TRPV5的表达呈正相关(r=0.52,P<0.05),与OPN的表达呈负相关(r=-0.69,P<0.05)。与对照组比较,模型组HK-2细胞中TRPV5和miR-22-3p表达显著降低(TRPV5为0.43±0.07比0.98±0.10,miR-22-3p为0.72±0.16比1.01±0.13),OPN表达显著升高(3.24±0.36比1.02±0.12),差异有统计学意义(t=13.517、75.794和17.551,P<0.05),细胞凋亡率[(17.37±2.09)%比(3.78±0.49)%]、cleaved Caspase-3(0.42±0.06比0.19±0.05)和bax(0.68±0.07比0.28±0.06)蛋白质表达均显著升高,bcl-2蛋白表达显著降低(0.14±0.03比0.31±0.05),差异有统计学意义(t=21.431、17.233、13.655、31.782,P<0.05)。与模型+miR-con组比较,模型+miR-22-3p组细胞上述检测指标均发生显著的负向调控。结论TRPV5和OPN在泌尿系统结石患者中的表达与miR-22-3p存在明显的相关性。     

腔内镜联用配合气压弹道碎石治疗复杂性上尿路结石

目的：探讨提高复杂性上尿路结石疗效的方法。方法：对21例复杂性上尿路结石患者采用经皮肾镜、输尿管镜、输尿管电切镜两镜或三镜联合并配合气压弹道碎石机治疗。结果：21例复杂性上尿路结石均一期治疗成功，一期结石取净率为90．5％，3个月结石排净率为100%，无严重并发症发生。结论：腔内镜联用配合气压弹道碎石治疗复杂性上尿路结石具有安全、高效、损伤小、周期短等优点。     

Effect of salmon calcitonin on deoxypyridinoline (Dpyr) urinary excretion in healthy volunteers

To evaluate the influence of synthetic salmon calcitonin (SMC) on bone resorption we investigated the modifications in urinary cross-links excretion [pyridinoline (Pyr) and deoxypyridinoline (Dpyr)] induced by a single dose of the drug. The study was carried out in 16 healthy volunteers given a single dose of either 50 IU SMC I.M. or placebo, according to a double-blind, cross-over design. Urine was collected every 24 hours during the 72 hours after each treatment and Pyr and Dpyr were measured by an automated HPLC method. Pyr showed no significant difference after the two treatments, whereas in the first 24-hour urine collection Dpyr (nmol/24 hours±SD) was considerably lower after SMC than after placebo (118.9±26.0 against 147.2±45.0, P<0.05). The amount of saved Dpyr was 19.2%. The selective effect of SMC on Dpyr excretion was more evident comparing the Pyr/Dpyr ratios for placebo and SMC during the first day of the study (4.1±0.6 against 4.8±0.7, respectively, P<0.01). Using Eyre's formula (10 nmol Dpyr =0.17 g bone) and assuming that no Dpyr is metabolized, the mean daily amount of bone resorbed was calculated (2.5 g for placebo and 2.0 g for SMC). The difference is the index of the bone-saving effect of SMC (0.48 g/day, or 19.2%). In conclusion, assuming that in healthy volunteers bone turnover is balanced with equal rates of formation and resorption, a dose of 50 IU I.M. of SMC reduces resorption, with a bone gain in the first 24 hours calculated as 9.4 mg/IU.     

"宽焦斑-低压力"电磁式冲击波碎石术治疗上尿路结石

目的观察"宽焦斑-低压力"电磁式体外冲击波碎石术(ESWL)治疗肾、输尿管结石的疗效及并发症.方法B超定位,应用CS-2012A型碎石机"宽焦斑-低压力"治疗泌尿系结石525例,工作电压6.5～9.0 kV,平均冲击剂量(1291±190)次.结果一次碎石后排净率51.5%,3个月后总排净率85.8%,碎石成功率97.9%,无严重副反应发生.结论"宽焦斑-低压力"电磁式体外冲击波碎石机治疗泌尿系结石安全性大,疗效满意.     

经皮肾微造瘘输尿管镜术治疗上尿路结石

目的 探讨经皮肾微造瘘输尿管镜治疗上尿路结石的方法。方法 应用经皮肾微造瘘输尿管镜术治疗上尿路结石23例。结果 23例经皮肾微造瘘输尿管镜手术均顺利完成，20例取净结石，2例结合ESWL治疗，1例结石细小未再治疗。结论 经皮肾微造瘘输尿管镜术是一种微创、安全、有效的治疗上尿路结石方法。     

Electron microscopy of urinary calculi — Some facts and artefacts

Summary Material in urinary calculi is prone to irradiation damage during electron microscopy and this suggests the need for care in the interpretation of data. It is shown, however, that minimum-dose transmission microscopy is feasible for single-crystal electron diffraction work, and that although internal damage in severe, morphological artefacts are unlikely in the SEM unless the incident electron flux is greater than 10^-13 A nm^-2. During EDX micro-analysis, the detection of light elements is impaired by irradiation effects unless a minimum-dose procedure is used. For the preparation of SEM samples, artefacts can be created by cleaving air-dried material-and it is therefore important to consider more lengthy preparation methods such as cryogenics.     

ESWL与腔内技术联合处理复杂性上尿路结石(附编者按)

目的　探讨复杂性上尿路结石的治疗方法。　方法　对近期 138例复杂性上尿路结石患者 ,采用体外冲击波碎石 (ESWL)与输尿管镜下气压弹道碎石 ,经皮肾微穿刺造瘘碎石、取石等腔内技术联合治疗。其中复杂性输尿管结石 110例 ,复杂性肾结石 2 8例 ,均有不同程度肾积水。对输尿管结石先行ESWL ,2 4h内再行输尿管镜下气压弹道碎石 ;对肾结石及输尿管镜碎石困难的输尿管上段结石 ,先一期行经皮肾微穿刺造瘘术 ,5～ 7d后行ESWL ,2 4h内再经肾造瘘通道行输尿管镜下气压弹道碎石、取石。　结果　结石总排净率为 97.1% (134/138) ,其中输尿管结石排净率为10 0 .0 % (110 /110 ) ,肾结石排净率为 85 .7% (2 4 /2 8)。无治疗失败病例。　结论　ESWL与腔内技术联合处理复杂性上尿路结石 ,降低了腔内手术难度 ,缩短了腔内操作时间 ,提高了结石排净率 ,患者创伤小 ,恢复快 ,并发症少 ,是治疗复杂性上尿路结石较理想的方法。     

经尿道输尿管镜下第三代碎石清石系统治疗婴儿膀胱结石及尿道结石合并急性尿潴留

目的 评价经尿道输尿管镜下第三代碎石清石系统(EMS)治疗婴儿膀胱结石及尿道结石合并急性尿潴留的疗效. 方法应用输尿管镜下EMS治疗三聚氰胺所致膀胱结石及尿道结石合并急性尿潴留患儿10例.男9例,女1例.平均年龄9个月.膀胱结石2例,尿道结石8例,结石直径0.5～1.1 cm,平均0.8 cm.全麻下行经尿道输尿管镜下碎石清石术,采用Wolf 8.0～9.8 F输尿管镜,在电视监视下,从输尿管镜操作通道伸入EMS超声碎石探针将膀胱结石及尿道结石完全粉碎吸出,术中膀胱内保持50～100 ml液体,灌注泵压力为160～210 kPa(1 kPa=10.20 cm H2O),平均180 kPa,超声碎石能量40%～60%,占空比30 0A～70%,平均60%.术后留置8 F双腔气囊导尿管. 结果 10例平均手术时间25 min,均将尿道结石冲入膀胱,在输尿管镜下一次性清除结石,麻醉清醒后拔除导尿管,均能立即顺利排尿.3 d后复查B超.膀胱、尿道内均无残留结石. 结论 对婴儿膀胱结石及尿道结石合并急性尿潴留患儿,应用输尿管镜下EMS清除结石,可以立即解除下尿路梗阻,恢复正常排尿,具有安全、高效、损伤小的优点,可作为膀胱结石及尿道结石合并急性尿潴留患儿手术解除下尿路梗阻的首选方法.     

中药泽泻中提取的化合物对尿草酸钙结石形成的影响

目的 通过乙二醇与氯化铵诱导的大白鼠肾草酸钙结石模型观察从中药泽泻中提取的三种化合物对尿草酸钙结石形成的影响,并探讨其抑制尿草酸钙结石形成的有效成分.方法 中药泽泻饮片,经药理学方法得到化合物Ⅰ、化合物Ⅱ、化合物Ⅲ.50只Wistar雄性健康大白鼠,随机分为5组,A组:正常空白对照组;B组:草酸钙结石成石组;C组:化合物Ⅰ实验组,在给予诱石剂的同时,每只大鼠每天灌胃化合物Ⅰ 1 ml,其他各实验组以此类推;D组:化合物Ⅱ实验组;E组:化合物Ⅲ实验组.各组在相同条件下饲养4周后,用代谢笼收集大鼠的24 h尿液检测24 h尿草酸(OX),Ca2+含量,断颈处死大鼠检测肾组织Ca2+含量,偏光显微镜下观察肾组织Von-Kossa's染色切片中草酸钙结晶大小,形态分布和肾小管损害程度.结果 C组24 h尿Ca2+(61.49±2.06)含量高于B组(37.23±1.84),差异有统计学意义(P<0.05);肾Ca2+(10.35±6.45)含量明显低于B组(49.20±9.63),差异有统计学意义(P<0.01);切片可见少量草酸钙晶体沉积和肾小管轻度扩张.结论 从中药泽泻中提取的化合物I能显著降低肾组织Ca2+含量和增加草酸钙结石大白鼠24 h尿Ca2+的分泌量,明显降低草酸钙晶体在肾脏的沉积和减轻肾小管的损害程度,因而化合物Ⅰ是泽泻抑制尿草酸钙结石形成的重要成分.     

Analysis of calcium,iron, copper and zinc contents of nucleus and crust parts of urinary calculi

Summary In this study we compared the concentrations of calcium, iron, copper and zinc in the nucleus and the crust parts of various kinds of urinary calculi. We found that the mean concentrations of iron, zinc and copper in the nucleus parts of the stones were statistically higher than those in the crust parts. We attempted to explain this finding by two different approaches. Inter-and intracorrelations were also sought between the elements in the nucleus and crust parts. These correlations suggested a complex relationship between the elements of the urinary calculi.